Lohnt sich Rehabilitation?

Abstract

Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.

Patient Reported Outcomes (PROs) – a Tool for Strengthening Patient Involvement and Measuring Outcome in Orthopaedic Outpatient Rehabilitation

“…The available data do not explain to what extent these observations also confound the PROs in terms of bias. In the past, other studies did not demonstrate any significant differences between inpatient and outpatient settings 3 , 4 , 5 , 6 .…”

“…In einer Reihe von Studien konnte gezeigt werden, dass zwischen ambulanter und stationärer orthopädischer Rehabilitation keine entscheidenden Unterschiede hinsichtlich der soziodemografischen Patientenmerkmale, der Patientenzufriedenheit, des klinischen Ergebnisses und des sozialmedizinischen Verlaufes bestehen 3 , 4 , 5 , 6 . Die ambulante Rehabilitation weist allerdings einen relevanten Kostenvorteil auf 4 , 5 .…”

“…Underpinned by the principle in the German Social Security Code that „outpatient treatment always trumps inpatient treatment“, outpatient rehabilitation in Germany has evolved quite positively since the turn of the millennium, particularly in orthopaedics. A number of studies have shown that outpatient and inpatient orthopaedic rehabilitation do not differ significantly in terms of sociodemographic patient characteristics, patient satisfaction, clinical outcome, and sociomedical course 3 , 4 , 5 , 6 . However, outpatient rehabilitation does offer significant cost savings 4 , 5 .…”

“…Seit dem Jahrtausendwechsel hat sich in Deutschland gestützt durch die im Sozialgesetzbuch verankerte Forderung nach „ambulanter vor stationärer Behandlung“ insbesondere im orthopädischen Bereich die ambulante Rehabilitation sehr positiv entwickelt. In einer Reihe von Studien konnte gezeigt werden, dass zwischen ambulanter und stationärer orthopädischer Rehabilitation keine entscheidenden Unterschiede hinsichtlich der soziodemografischen Patientenmerkmale, der Patientenzufriedenheit, des klinischen Ergebnisses und des sozialmedizinischen Verlaufes bestehen 3 , 4 , 5 , 6 . Die ambulante Rehabilitation weist allerdings einen relevanten Kostenvorteil auf 4 , 5 .…”

“…Inwiefern diese Beobachtungen im Sinne eines Bias auch Einfluss auf die PROs haben, lässt sich mit den zur Verfügung stehenden Daten nicht klären. Weitere Studien hatten in der Vergangenheit keine relevanten Unterschiede der Patienten im ambulanten und stationären Setting gezeigt 3 , 4 , 5 , 6 .…”